Effective olanzapine dose ranged from 5-20 mg. A significant decrease in agitation with moderate to very large effect (Tau-U effect size = 0.37-0.86) was observed for three of five participants receiving olanzapine, while no significant reduction in agitation over the PTA period was observed for any participant receiving placebo. All participants received recommended environmental management for agitation. Eleven agitated participants in PTA (mean age = 39.82 years, standard deviation = 20.06 mean time post-injury = 46.09 days, SD = 32.75) received oral olanzapine (n = 5) or placebo (n = 6) for the duration of PTA, beginning at a dose of 5 mg/day and titrated every 3 to 4 days to a maximum dose of 20 mg/day. Group comparisons were additionally conducted, examining level of agitation number of agitated days agitation at discharge, duration, and depth of PTA length of hospitalization cognitive outcome adverse events and rescue medication use. ![]() This study, conducted in a subacute inpatient rehabilitation setting, describes the results of a double-blind, randomized, placebo-controlled trial investigating the efficacy of olanzapine for agitation management during PTA, analyzed as an n-of-1 series. ![]() The sedating and cognitive side effects of these agents are theorized to exacerbate confusion during PTA, leading to prolonged PTA duration and increased agitation. ![]() Antipsychotics are frequently used to manage agitation in early TBI recovery despite limited evidence to support their efficacy, safety, and impact upon patient outcomes. Further high-quality research is required to support these findings and the efficacy and outcomes associated with the use of any pharmacological agent for the management of agitation during the PTA period.Ībstract = "Agitation is common during post-traumatic amnesia (PTA) following traumatic brain injury (TBI) and is associated with risk of harm to patients and caregivers. When utilizing olanzapine, physicians must therefore balance the possible advantages of agitation management with the possibility that the patient may never respond to the medication and may experience increased confusion, longer PTA and potentially poorer outcomes. Importantly, administration of olanzapine during PTA may lead to increased patient confusion, possibly prolonging PTA. These results suggest that olanzapine can be effective in reducing agitation during PTA, but not universally so. No further group comparisons were statistically significant. In group analyses, participants receiving olanzapine demonstrated poorer orientation and memory during PTA with large effect size (olanzapine, mean = 9.32, SD = 0.69 placebo, M = 10.68, SD = 0.30 p = .009, d = -2.16), and a trend toward longer PTA duration with large effect size (olanzapine, M = 71.96 days, SD = 20.31 placebo, M = 47.50 days, SD = 11.27 p = 0.072, d = 1.26). Response to treatment was characterized by lower level of agitation and response to treatment within 3 days. ![]() Agitation is common during post-traumatic amnesia (PTA) following traumatic brain injury (TBI) and is associated with risk of harm to patients and caregivers.
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